Provider Demographics
NPI:1619094554
Name:MOONEY, MARLA JO (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:JO
Last Name:MOONEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOISINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67544-1842
Mailing Address - Country:US
Mailing Address - Phone:620-653-2200
Mailing Address - Fax:620-653-7386
Practice Address - Street 1:821 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOISINGTON
Practice Address - State:KS
Practice Address - Zip Code:67544-1842
Practice Address - Country:US
Practice Address - Phone:620-653-2200
Practice Address - Fax:620-653-7386
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist